Aiming for more efficient patient monitoring

How often nurses should check patients’ blood pressure, temperature, respiration rate and other indicators of health is being examined by researchers.

The research, led by the University of Portsmouth and funded by the National Institute for Health Research, aims to identify the ideal frequency of observations for keeping patients safe while avoiding unnecessary extra work for busy staff.

The project will focus on the use of the National Early Warning Score (NEWS), a system in place in most UK hospitals to spot signs of deterioration among patients. NEWS consists of the “vital sign” measurements of pulse, respiration rate, blood pressure, temperature, oxygen saturation and alertness and recommends that all patients should be checked at least twice a day. Patients who are more unwell may need checking more frequently.

However, checking too often can be annoying for patients and interfere with rest and sleep which are important to recovery.

Nurses also need to plan their time well to look after patients who need care.

Lead investigator Jim Briggs, Professor of Informatics at the University’s School of Computing, and Director of the Centre for Healthcare Modelling and Informatics, said: “We know that early warning scores identify patients suffering clinically important deterioration in their condition, and the National Early Warning Score used in the NHS has been well validated. However, there has been no work about how often the measurements that underpin NEWS should be undertaken.

“We want to see if we can answer the question: ‘how often should vital signs be taken?’ Some observations could be unnecessary or too far apart to be useful in spotting deterioration. We aim to provide the first evidence-based protocol for patient monitoring, which will be both safe and achievable across all acute NHS hospitals.”

The research project will use vital signs observation data from general wards at two hospitals, which use electronic systems to record the data and calculate an early warning score. As well as identifying clinically important changes in a patient’s condition, early warning scores recommend when the patient should next be observed. Currently there is no evidence to suggest how long the time between observations should be.

Co-investigator Peter Griffiths is Professor of Health Services Research at the University of Southampton. A clinical nurse by background, he said: “An important part of nurses’ work in hospitals is monitoring patients’ condition in order to spot when patients are getting unwell. Despite how crucial the work is, decisions about how often to take these vital signs observations have, until now, largely been an evidence-free zone.”

Dr Paul Schmidt, consultant physician at Portsmouth Hospitals NHS Trust and one of the clinicians involved in the project, commented: “Nurses in our hospital take patients’ observation over one million times a year. That requires a lot of precious nursing time and effort. We would like to ensure all that effort is necessary and used wisely to keep patients as safe as possible.”